Assessment of Menorrhagia in Females Followed for Bleeding Disorders at the Hemophilia Center of Western New York-Correlation between Clinical Presentation and Laboratory Parameters.

Menorrhagia is a common problem among women. The pathophysiology has been attributed to Von Willebrand’s disease in some patients. The lab diagnosis and confirmation of this condition in these women is often difficult. The need for easily reproducible, validated lab investigations is recognized. The platelet function analyzer (PFA-100) (described below) has recently been used as an adjunct for lab diagnosis of this condition. Use of this device is relatively recent, thus clinical correlation with its results have been lacking. Therefore, we initiated a study to determine if a correlation could be established between pictorial blood assessment chart (PBAC), PFA-100, and Von Willebrand’s screening (VWF antigen and co-factor activity levels).

Materials and methods: After obtaining informed consent 15 female patients with a diagnosis of von Villebrand’s disease were enrolled in the above study. All received verbal and written instructions of how to record their tampon/pad use on the PBAC. The PBAC was then scored on a validated and well-established point system for lightly (1point), moderately (2points) and heavily (3points) soiled pads or tampons. In addition their blood samples were analyzed for von Willebrand antigen, Ristocetin Co-Factor and on the PFA-100 (pre and post DDAVP). The PFA-100, is a high shear-inducing device which simulates primary hemostasis after injury to small vessel, which consists of a reservoir for whole blood and a small capillary surmounted by a collagen-coated membrane with a central aperture. Platelet agonist which is either epinephrine or ADP is present on the membrane. Closure time is reported as a variable which describes von Willebrand factor function. All blood samples were forwarded to Children’s Hospital of Buffalo Special Coagulation lab for examination of the PFA-100(pre and post DDAVP),and von Willebrand panel.

Conclusion: There was correlation between the number of points self-assessed on the PBAC and the PFA-100.